Patterns of failure in cervical carcinoma and outcome of salvage therapy: a retrospective study

The objective of this study was to study the patterns of failure after definitive therapy in cervical cancer, the treatment given to patients after recurrence and the final outcome in these patients.

Case records of 105 patients of cervical cancer of clinical Stages I to IV treated with definitive radiation or surgery with or without post-operative radiotherapy at Kuwait Cancer Control Centre (KCCC), Kuwait from 1995 to 1999 were retrospectively analyzed. Patients who developed recurrence were studied for the pattern of their recurrences, the type of treatment received by them after their recurrence and the results of their salvage therapy.

The sites of failure were classified as pelvic only (P), pelvic+ distant metastasis (P+DM), or distant metastasis only (DM). Out of the thirty patients in stage Ib, the sites of first failure were, P = 5 (16.6%), P+DM = 1 (3.2%), DM = 1 (3.2%); of the fourteen patients in stage IIa, P = 2 (14%), P+DM = 1 (7%), DM = 2 (14%); of the 36 patients in stage IIb, P = 3 (8%), P+DM = 6 (16.5%), DM = 5 (14%); of the 14 patients in stage IIIb, P = 5 (35.5%), P+DM = 1 (7%), DM =0 (0%); of the 5 patients in stage IVa, 3 patients absconded after treatment and the failure rate was, P =0 (0%), P+DM = 0 (0%), DM = 1 (50%). The therapy after failure was surgery, irradiation, chemotherapy or supportive care. The median survival was evaluated as a function of time to failure after initial treatment and was 6, 6, 9, and 30 months for those failing less than 6, 6-12, 13-24 & 25-36 months after initial treatment respectively. The cohort treated initially with surgery had a better outcome of salvage therapy at relapse.

Long term survival can be achieved in a small percentage of selected patients who fail treatment with definitive radiation or surgery for invasive carcinoma of the uterine cervix. The probability of survival is greater for those who fail more than 24 months after initial treatment than for those who fail before 24 months. The chance of survival is also related to the initial type of treatment, site of recurrence & type of salvage therapy. The complications of salvage treatment of recurrent disease should be minimized.